03060103 M CITY OF CUPERTINO " ' �"� + -"` `7�" �C' 'E
BUILDING DIVISION PERMIT "aGONTRACTUR INx'ORMATIO
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LDING ADDRESS: LOS' GATOS ROOFING PERMITNo03060103
OWNER'S NAME: - 1771 SMITH AVE. PERh9TI4xVEDAJQ 3/2003
NE: (4 08) 298-9399 SANITARY NO.
1 CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
30p LICENSED CONTRACTOR'S DECLARATION ' O O O
0 I Wmby affirm Nat 1 am licensed under provisions of Chapter 9(commencing Job Descr'PY
with Sm,ion7ID )af Divlalon3ofthe Busi.umd Prafcuiona Co&.mdmyliccnwis
I.full forte end effec
Licensee] �39 Lie.q 100707 REROOF
;~F Date b /3 d7 Contrxror d ,.di JUII i 1 2003
q ARCHITECTS DECLARATION
2 I understand my plana shall W used u public records
:t BUILDING y�7
Licensed Profesaionel BUILDING
OWNER-exempt R DECLARATION
I coo I hereby maso alarm Nat I em exempt from the Contractor's License tow for tW
O O following moon.Permit
t AI3,Construct,Alm,. and Professions Code:Any cily ar.unty
5$ which rtqus u•permit n rtsthealter,Wprove,demolish,car repair any mucmm
_i!^e poor Mat he its issua.etlmrequiree the Applicant for such permit toice.le a Law(Cha mens
< N.t he I.licensed punuentmthc provisionsof the Contracmr'Woou.law(Capmr9 Sq. Ft.Floor Area $1Ig;tI00
91- (commencing with Section 7(IIID)or Division 3 of tie Business and Prafculam COCA)or
egg Net a 4 exempt therefrom and she basis for the alleged exemption.Any violation of
Sermon 7031.5 by any applicant for a permit subjects the applicant an•civil penalty of 3 ARN DM&&T 0 0 Occupancy Type
not more Nan five hundred dollars(5500).
I,as..or or the property..my cmployO.with.,A a del,vele ecomc.ution,
will the Ne wmk.md Neswnure Is not intended oroRemd forsale(Sm.IDU,Business — g�
And Profemmus Cade:The Com,mtm's Lianas Law does not apply m an Owner of 3 0 7 - INSULA d Inspections
property who builds or The
thereon,and who daessuchwmk himaelf orthrough his
Avon employees.provided that such improvements are notimendedoroOemA formic.If. 601 — ROOF TEAR OFF
however,Ne building or improvement Is mid within one you of completion,Ne owner-
bullder .will have the burden of proving that rte did not build or Improve for purpose of 602 - ROOF PLYWOOD NAIL
sale')' 603 - ROOF BATTENS
01.as owner of the property,am exclusively contracting with licensed convectors to 604 - ROOF IN-PROGRESS
Construct Me project(Sec.70/4,Business and Professions Code:)The Conmmuos Li-
cense Law docs not apply to an owner of property who builds or improves Hereon,and
who contracts for such projects wish a contractors)licensed pursuant to the CanuamaYa
License Law.
❑Iamexemptundersec. ,Btk PCfmthbmtsnn
Ownu Dae
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of pedury one of the following decimations:
I have and will maintain a CenlOnte of Consent self-insum for WortmesCmopon-
aatian,u p,ovided(m by Section J700 of Ne labra Code,for the performance of Ne
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,u required by Section
3710 of Me labor Code.for Ne performance of the work for which Nu permit is Wued.
My Worlues Commando n IGnsurancAe tamer and Policy number arc:
Cartier. .S Mn /UNU Policy No.: z7�7 —L0 O3
CERTIFICATE OP EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(r ossection need not Meomplemd if Ne Permit isforonc hundmddollars($100)
.less.)
I C.dfy Nat in Ne perform...of the work for which Nia Permit Is luded.I Mall not
employ any person in any manner an As in become subject to the Workers Compensation
Laws of California Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become suhjmt in Ne Worker',Compensation provisions of the Labor Code,you mon
.,Z forthwith comply with such provisions or this permit shall W doomed revoked.
z CONSTRUCTION LENDING AGENCY
1 arch,.Mon Nat there its chummed..lendingagcy for de performe.c of
Yr the work for which this permit Is issued(Sec.3097.Civ.C.)
31 Q Lower',Name
zbuilder's Address
J Q 1 certify Nat 1 have read this eppllcmion and sum dial mac above Information is
y F corren.I agree to comply with all city and county ordinances and auto laws relating to
QU 41howngeonsned proved herfor by Insuthormrposes. ivcaofNis city to enter upon the
P. shout-(We) gree to cny for indemnify
An IMCP es.
.w esju agree m on,indemnify and kith hay In an the City e of against s against
Z inccumcquenc.ofinecostsmd expenses which may in any way seethe against said City
J`L in conmy.nce of Ne granting or this Tercels
^ APPLICANT UND TANG A D WIL OMPLY WITH ALL NON-PpppINT Issued by: Da
SOURCE RE� 0 /�
b am Re-roofs
Signature of ApplieaHAZA DO Dare
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII Ne applicant or future building aceupmt mwe Ar analis lHealth and
As defined Section
de Cupertino Municipal Cala.<ltspmr 9.13,and the HaIN m0 safety
c.5-]Yes 35533(.)7 All roofs shall be inspected prior to any roofing material being installed.
E-]Yes -®NA
von the applicant or Noure building Occupant use equipment or devices which 'If a roof is installed without first obtaining an inspection,I agree to remove
Id.
I h mando.air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
rict7
❑Yea Gs N.
I have mad the huurdous materials requirements under Chapter 6.95 of the Califor-
Health&Safety Cale,sections 25505,35533 and 1534.I understand that if Ne Wilding ///!� 6-113
�63
im cumcntl b;z=-"
is/ mnodfy uY0nf NcIrementswn Wmet mi rear dfi.amarOce Signature of Applicant Date
/3 03
owner Ar.wnarl]aa seal �' �— All roof coverings to be Class "B"or better
Building Division
It
10300 Toren Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CI Fax: (408)777-3333
CUPERTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
2. New roof coverings shall not be applied without first obtaining all inspection
'and written approval from the building inspector.A final inspection and
approval shall be obtained from the building inspector when the reroofing is
completed.
3. All roofs shall be inspected prior to any roofing installation
4. To receive a final sign off from the City the following steps are required.
1) Preinspection and/or tear off approval.
2) In progress inspection approval
3) Final inspection approval.
a) Spark arrester installation
5. If plywood is installed,a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,will
require the removal of all new material down to the she so that the
proper City inspection can be performed.
IMPORTANT:
I. Flat roofs must have a minimum of VV'per foot slope and demonstrate that
there is no ponding.
2. An I.C.B.O.report is required to be on the job site at the time of inspection
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name
Address:
Reroofing Company Name:
Applicants Signature: Date:
Joe
Antonucc! ^_
(Chief Building Official)
6/25/01
CITY OF CUPERTINO f
G� REROOF °� ' °
cil OF
CUPERTINO PERMIT APPLICATION FORM
APN# /,
13 —CJS Date: F
Building Address lA
Owner's Name: // Phone License#:# //� C
a (o�SS �J
Contractor: Phone# :
Los G� fos zP p� �oo�0 7
Contac kj Phone#: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) �G Other(Specify) 7t "JSA30#F e I t
Number
mber of existing coverings�_ ❑ Provide I.C.B.O. eport#
To be Removed Provide Mfgr.Installation Specs.= 3'a „ Fxp
• I Have Read, Understand and Will Comply With Cu erttiino's Tear Off Policy:
Job Description:
Residential Commercial %❑
Fire Zone: Yes ❑ No Confirmed with Planning D ,PI. if
there are an restrictions: Ee
Cost of Project: Type o Constru tion: Occupancy gr up:
0000 '
Qty. if
AA
Fee ID Fee Description Fee Group
MFEE —[_BldgPermit Fees BUILDING
RGY Ener BUILDING
MICRE Seismic Fee Res BUILDING
MICOM Seismic Commercial BUILDING
NCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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